Interoception, categorization, and symptom perception

Abstract

Medical practice and the disease model importantly rely on the accuracy assumption of symptom perception: patients’ symptom reports are a direct and accurate reflection of physiological dysfunction. This implies that symptoms can be used as a read-out of dysfunction and that remedying the dysfunction removes the symptoms. While this assumption is viable in many instances of disease, the relationship between symptoms and physiological dysfunction is highly variable and, in a substantial number of cases, completely absent. This chapter considers symptom perception as a form of unconscious inferential somatic decision-making that compellingly produces consciously experienced symptoms. At a mechanistic level, this perspective removes the categorical distinction between symptoms that are closely associated with physiological dysfunction and those that are not. In addition, it brings symptom perception in accordance with general theories of perception. Some clinical implications to understand and treat symptoms poorly related to physiological dysfunction are discussed.

‘The body says it’: the difficulty of measuring and communicating sensations of breathlessness

“…As our object of study is the multimodal sensation of breathlessness (and attempts to describe and express it vs attempts to measure and report it), we have approached the study of breathlessness from a sensorial anthropology vantage point. 5 The anthropology of the senses is one of numerous approaches that emerged out of the sensory turn in the humanities and social sciences beginning in the 1990s. 6 Laplantine, one of the key theorists of the sensorial nature of ethnography, does not view the senses as objects of study but as ways into understanding and perceiving the multiplicity of lived experience.…”

“…5 The anthropology of the senses is one of numerous approaches that emerged out of the sensory turn in the humanities and social sciences beginning in the 1990s. 6 Laplantine, one of the key theorists of the sensorial nature of ethnography, does not view the senses as objects of study but as ways into understanding and perceiving the multiplicity of lived experience. His first book to be translated into English, The Life of the Senses, reminds us in the prologue that our role as anthropologists is to critique Eurocentric ways of seeing-one of which is the hierarchical distinction between knowing and sensing.…”

Making Breath Visible: Reflections on Relations between Bodies, Breath and World in the Critical Medical Humanities

“…The body is a burden best ignored, and staying inactive, in order not to notice it, the optimal state of being. This tendency, along with the dampening effect of emotional states, is likely to contribute to the problem of symptom discordance in breathlessness (van den Bergh et al, 2019: 213).…”

“…Van den Bergh and colleagues reflect upon the idea of accuracy in relation to symptoms (van den Bergh et al, 2019). They note that in the clinical context the idea of symptom assessment and consequent diagnosis depends upon the idea of accuracy.…”

“…Symptoms themselves are rarely the focus of clinical interest, only what they apparently have to say about the physical state of the body. Van den Bergh et al suggest that this ‘accuracy assumption’ represents a ‘fundamental implicit contract among the patient, the physician, and the healthcare system’ (van den Bergh et al, 2019: 213). However, this only works under circumstances when the relationship between physiological stimulus and perceived symptom is simple.…”